Trust your doctor to save?

Dr. Richard Young, a Fort Worth family physician who says the nation is spending its way to ruin on health care, is the sole Texan selected recently as an adviser for the federal government’s new medical Innovation Center.

Young argues that family physicians could do a lot more to hold the line on spending if they were more central to a patient’s treatment. But when he sees Medicare or Medicaid patients at Tarrant County’s JPS Physicians Group, he can only deal with one ailment at a time. Even if a patient has several chronic diseases — diabetes, congestive heart failure, high blood pressure — the government’s payment rules allow him to only charge for one.

“You could spend the extra time and deal with everything, but you are completely giving away your services to do that,” he said.

Patients are told to schedule another appointment or see a specialist.

This sounds simpler than it is. Young calls the payment rules “ridiculously complicated.”

“Let’s say I see a patient with diabetes, where their sugar is out of control. They might be dealing with financial issues. There might be a lack of understanding about the importance of taking their medications. The way the point system works, I’m expected to basically ask the patient about issues on diabetes, examine a certain number of body parts, ask questions, probably change prescriptions around a bit,” he explained.

“If they also have high blood pressure, a bump on the skin or anything else like that, OK, I examine a few more body parts, deal with another issue and another prescription, but basically with just the diabetes, I’ve maxed out the number of points I can bill for.”

By choosing him as an innovation adviser, the federal government’s Centers for Medicare and Medicaid Services (CMS) is inviting Young to come up with a better design. He’ll be given a grant to spend several hours a week on his proposal, and to attend meetings in Washington and elsewhere trading ideas with other innovators.

The CMS Innovation Center was created by the 2010 health care overhaul law. Its aim is to find and prove methods of increasing the value of medical care that can be shared nationwide. The center hopes to find solutions that will save more than half a trillion dollars in Medicare spending over the next 20 years.

Young argues that family doctors are the key. When patients see the same doctor each time they seek medical care, a relationship develops. A personal physician can keep spending under control by reining in unnecessary tests, treatments and imaging.

Young has a blog — healthscareonline. com — where he argues that Americans are pushed into needless medical care, and that doctors have an obligation to talk frankly with their patients about a more common sense approach.

“When a patient has finished two rounds of debilitating chemotherapy without much success, should I encourage more treatments or say, ‘Pam, I think it’s time to focus on keeping you comfortable and getting the most out of the time you have left,’” Young writes in his blog’s mission statement.

What Young asks is that patients trust their doctors, and pay them more for their services. That doesn’t sound like a way to save money. But Young says too much money now goes to specialist care and overaggressive testing and diagnosis. He calculates that having a personal physician in charge who avoids much of this could cut annual spending by 20 percent.

“If you pay family docs to be more comprehensive than they currently are, and bring more family docs into the population, then cost savings will naturally flow out of that,” he said. “Maybe it will work, maybe it won’t. What’s cool is that CMS is finally looking for payment options instead of forcing people to stay with the old payment rules.”

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About Jim Landers

MOST UNFORGETTABLE EXPERIENCE ON THE JOB: Traveling by steam locomotive through the night in China in 1985.

SOMETHING PEOPLE DON'T KNOW ABOUT ME: I'm bashful.

IF I HAD TWO SPARE HOURS, I WOULD: Write.

Hometown: Fairfax, Virginia

Education: Graduated in English, with honors, Virginia Tech '74. Joined The Dallas Morning News in 1981 after two years in Saudi Arabia, one in Montana, two in New Jersey, one in Richmond, one in Northern Ireland and a couple more in the Washington, D.C., suburbs.